H5N1

Advice for Haiti from The New York Times

An editorial: Haiti After the Vote. Excerpt:

Sunday’s elections in Haiti were sullied by low turnout, polling-place confusion and accusations of voter intimidation, ballot stuffing and other fraud. But for all those flaws, international observers from the Organization of American States and the Caribbean Community agree with Haiti’s national election council, which has declared that the election was fundamentally sound. 

Twelve of Haiti’s 18 presidential candidates were unpersuaded on Election Day when they declared — without evidence, and before the polls had closed — that the voting had been hopelessly tainted and should be canceled. 

Two of them — Mirlande Manigat, a former first lady, and the musician Michel Martelly — backed away on Monday, perhaps because they seem to be the two front-runners heading toward a runoff in January. 

Re-running elections this large — not just for president, but for 11 members of the 30-member Senate and the entire 99-member lower house of Parliament — would lead to months more of confusion and government inaction. Unless compelling evidence of fraud is found, it is not necessary and clearly not in Haiti’s interest. 

Right now, election officials need to press ahead with an open and honest vote count. International monitors need to keep a close watch and quickly revise their assessment if they see serious problems. 

Preliminary results are expected Dec. 7. If no presidential candidate gets 50 percent of the vote — likely given the size of the field — then everyone involved needs to learn from Sunday’s problems and work a lot harder to minimize chaos in the next round.

A new resource

As the post just below indicates, I've discovered the Pulitzer Center on Crisis Reporting. You'll find another link to it in the Technical Sources list in the middle column. The site has a far broader scope than infectious disease, but its reports give a valuable perspective on the Gordian knot of poverty, exploitation, ignorance and disease that besets us all (and I include those of us in the so-called "advanced" nations).

Haiti: Not only cholera but also AIDS

Via the Pulitzer Center on Crisis Reporting: After the Earthquake: Looming AIDS Crisis in Haiti. Excerpt:

Haiti used to be a model for combating AIDS. Experts at first thought the epidemic might wipe out a third of the population. But instead the country became a surprising success story: Thanks to significant financial support from the U.S. President's Emergency Plan for AIDS Relief as well as the Global Fund to Fight AIDS, tuberculosis and malaria prevalence rates fell from 9.4 percent in 1993 to 2.2 percent in 2008. 

January’s earthquake, however, destroyed many health facilities, and experts are afraid that with the high rates of rape, prostitution, and promiscuity in the camps, there will be an explosive increase in the number of new HIV infections. 

“I think we could well have 200,000 to 300,000 affected by HIV,” says Esther Boucicault, founder of Foundation Esther Boucicault Stanislas, a grassroots HIV/AIDS organization. “Because what can you do in a tent? Nothing. Nothing, no entertainment, nothing. The only thing you can do is sex. So you have sex.” 

Doctors doing HIV testing at a clinic at one of Haiti’s many tent camps are seeing at least 15 to 20 new cases each day in that one camp alone, says Beatrice Dalencourt Turnier, a social mobilization officer at The Joint United Nations Programme on HIV/AIDS. 

Shortly after the earthquake, Turnier and her team tried to distribute condoms in the camps, but those in charge of the emergency response did not see this as a priority. 

“Once somebody has access to food, to water, to shelter, the next need is affection and sex,” says Turnier. “But it's very difficult for people that work in an emergency to understand that. When people are giving out food and you're telling them they need to give condoms, it's like ‘Why do you want to bother me with that?’”

Meanwhile, back in Flublogia...

While I've been obsessing over cholera and politics in Haiti, others are minding the store. Among them is CIDRAP, which has published a new FLU NEWS SCAN: Avian flu in Japan, US flu activity, anti-vaccine ad, H1N1 in dogs, H1N1 Twitter traffic. Excerpt:

Toronto researchers who analyzed the volume and content of Twitter traffic during the 2009 H1N1 pandemic found that news and information were the most common tweet topics and that patterns varied over the course of the pandemic. 

Their report appeared yesterday in Public Library of Science (PLoS) One. Using both automated and manual systems, they looked at a random sample of about 5,400 tweets from more than 2 million that appeared between May 1 and Dec 31, 2009. 

They found that the posts' wording evolved from "swine flu" to the preferred "H1N1" terminology and that public health events such as the World Health Organization's pandemic declaration and major news stories prompted spikes in tweets. 

Information on protective behaviors peaked as the outbreak threat increased, and reports of personal experiences with the flu rose during the two pandemic waves. News Web sites were the most popular sources cited (23.2%), and only 4.5% of tweets were identified as misinformation. 

The investigators concluded that social media such as Twitter are useful for gauging knowledge during public health events.

Click through to find the link to the PLoS One report. Anecdotally, I can confirm that Twitter has become my preferred source for news posts from Haiti.

In addition to CIDRAP, you should be visiting Avian Flu Diary, Arkanoid Legent, and Chen Qi for the best surveys and analysis of what's going on in infectious diseases around the world.

For more specialized sites, see Superbug, Bird Flu Information Corner, and virology blog. And browse around in the Bloggers and Forums lists. Flublogia is a bigger country than it seems.

Haiti elections process stabilized and on track: U.N.

Via Reuters: Haiti elections process stabilized and on track: U.N. Excerpt:

Haiti's elections at the weekend were "fairly good" and were not derailed by the call for annulment made by a group of presidential candidates, two of whom later recanted, the top United Nations official in the country said on Tuesday. 

"I'm more confident right now than I was two days ago," Edmond Mulet, the head of the U.N. mission in Haiti (MINUSTAH) told Reuters in his office near Port-au-Prince airport. 

During voting on Sunday, 12 of the 18 presidential candidates, including several known frontrunners, shocked the U.N. and international observers by jointly denouncing "massive fraud" and calling for the cancellation of the polls. 

The call, made amid protests in the capital against voting problems, created a credibility problem for the troubled elections in Haiti, which is in the grip of a deadly cholera epidemic and recovering from a devastating January 12 earthquake. 

This surprise move by a majority of candidates seemed to threaten the international community's hopes that the elections, which may well go to a second round in January, could produce a stable, legitimate new government to lead the poor Caribbean nation's recovery from the earthquake. 

But in 24 hours, and facing heavy diplomatic pressure as their supporters took to the streets, Michel Martelly and Mirlande Manigat, both election frontrunners in the group of candidates rejecting the vote, changed their position and said they wanted the process to go ahead and counting to proceed. 

"I think that the concerns and problems we were facing last Sunday are behind us and we'll see what will happen in the next days," Mulet said, adding he believed the situation had "stabilized" after the street protests and fears of violence. 

U.N. peacekeepers were still escorting ballot papers and voting tallies in from around the country, an operation that would be completed late on Wednesday, Mulet said. 

Haiti's Provisional Electoral Council (CEP) was due to announce preliminary official results on December 7.

Haiti: INITE accepts defeat

Via BBC News and a tweet from #MissionManna: Ruling party accepts defeat. Excerpt:

Haiti's ruling INITE (UNITY) Party has acknowledged that it may have lost Sunday's elections which were marred by allegations of fraud. 

The announcement has raised hopes of a peaceful power transfer in the quake-hit and cholera-gripped nation. 

International election monitors including the Organisation of American States and the Caribbean Community (Caricom) have said that the elections were valid, despite what they called serious irregularities. 

However the Institute for Justice and Democracy in Haiti has denounced the elections and called for a new national poll. 

It says the country deserves elections that are in compliance with the rule of law in Haiti.

Wikileaks, Cablegate and Haiti

Ansel Herz has updated his latest Mediahacker post: Wikileaks, Cablegate and Haiti. Excerpt (his bolding):

A just-released 2008 cable from the American Embassy in Brasilia includes commentary about MINUSTAH, the UN peacekeeping force in Haiti led by Brazil: 

“Brazil has stayed the course as leader of MINUSTAH in Haiti despite a lack of domestic support for the PKO (peacekeeping operation). The MRE (Brazil’s Ministry of External Relations) has remained committed to the initiative because it believes that the operation serves (Foreign Minister) FM Amorim’s obsessive international goal of qualifying Brazil for a seat on the UN Security Council.”

Click through to Herz's site for a link to more discussion of this cable about MINUSTAH.

Another point of view on the Haitian elections

Now that I've discovered Frank and Jillian Thorp through their blog On the Goat Path, I'm planning to spend a lot of time with them. Here's another excellent post, with great photos: Elections in Haiti Experience Widespead Irregularities As Candidates Call for New Vote. Excerpt:

About 3 months ago I started to make a point of asking the Haitians I would speak to if they were going to vote, and 90% of them said ‘no’.  The responses were typically the same, but included at least one of these reasons: 

1. I don’t have a voter registration card. 

2. I don’t really care. 

3. The government doesn’t do anything anyways. 

4. I don’t like any of the candidates. 

5. It doesn’t matter who I vote for, they will steal our money no matter what. 

While many of these complaints are the same no matter where you vote, the reality is that the government here has never given the people a good reason to participate in the democratic process.  Preval is the first president in the history of Haiti to be elected into office and finish his term (if he finishes it in January, of course), and he has done a terrible job.  The country continues to deteriorate, especially after the earthquake, and the government has done nothing to stop it. 

Unfortunately, the heavy presence of NGOs, both large and small, has not helped this situation either. Aid organizations are, in fact, incredibly un-democratic, considering that they cause people to rely on them instead of the government. They provide Haitians with the goods and services that a government should be providing, so when the population is in need they don’t go to their local officials, they go to the aid organizations instead. Whether or not the government can provide those services doesn’t matter, they have been dis-empowered to the point of being irrelevant in their own country, which is never a good thing.

Dr. Wilson: "The epidemic continues to spread completely out of control"

Dr. Jim Wilson updates his Current Map of Cholera-Affected Areas - Haiti: Operational Biosurveillance. Excerpt (his bolding):

•Case fatality rates such as the most recent Health Cluster report of 2.3% is representative of gross national level aggregation of information available to officials, which represents a substantial bias towards CTC/CTUs staffed by experienced teams such as MSF.  What is not reflected is the continually documented "first contact" pattern of daily clinical mortality seen by rural communities and urban environments such as Gonaives several weeks ago reported by officials do not reflect the true impact of cholera at the community level. The daily mortality we have documented on multiple occasions may range from 10 to 100%.  We often see sudden overwhelming of local capacity to the point of backloading corpses for burial, having run out of body bags. 

•Conservative estimates therefore suggest more than a quarter-million cases of cholera in Haiti to-date, the majority of which were subclinical.  

•In some areas of Haiti, we have confirmation that in-patient statistics are under-reported by as much as 400%. In many areas of Haiti, we are documenting outbreaks that are not being accounted for in the official statistics. We therefore estimate the upper bound of estimated total (subclinical and clinically apparent) case counts to be nearly one million. From a practical operations point of view, these estimates are academic. The bottom line is the epidemic continues to spread completely out of control.

World AIDS Day and a disease that’s no longer a cause célèbre

Via The Star, some thoughts for tomorrow: World AIDS Day and a disease that’s no longer a cause célèbre. Excerpt:

As a cause célèbre, AIDS is no longer as sexy or compelling as it once was, losing much of its national and international cachet over the last couple of years. 

The disease no longer grabs as many headlines. Politicians no longer feel compelled to be seen to invest huge dollars into research, transmission and prevention of the disease in the developing world. And closer to home many in the developed world, at least, treat the disease as nothing more than a chronic irritation. 

As the world gets ready to celebrate World AIDS Day 2010 on Wednesday, many lament the apparent lack of interest in the disease. AIDS fundraising continues, but many donors turn a deaf ear and have turned to other issues and organizations. And the United Nations promise to have universal care, treatment and prevention of HIV by 2010 has yet to be achieved. 

Thirty years after AIDS made headlines, the world’s attention has turned to other things: tuberculosis, malaria, malnutrition, mother and child health, Haiti, and the strengthening of the health system worldwide. 

“I think back in the early days of the epidemic there was a sense of urgency that somehow has been lost,” said Dr. Julio Montaner, the Director of the British Columbia Centre for Excellence in HIV/AIDS in an interview with the Star. 

Put simply, AIDS is no longer sexy, agrees Montaner, who also serves as the Chair in AIDS Research and Head of Division of AIDS in the Faculty of Medicine at University of British Columbia, and the Past-President of the International AIDS Society. 

Partially it’s because in North America many no longer face a certain death if diagnosed with AIDS. Thanks to daily medication, most people here with AIDS live long and productive lives, he said. The same cannot be said in the developing world, where the epidemic continues to be “devastating and killing.” 

“But if you’re not there and don’t see it, it’s pretty easy to move on and say, ‘Let’s focus on our priorities’,” Montaner said. For Montaner maintains that deep-seeded discrimination and stigma has resulted in decreasing interest in the disease. 

“We still embrace equal opportunity and same-sex marriage but, to be frank, it’s window dressing. Stigma and discrimination still exist in our environment.”